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Acute, or short-term,
complications of diabetes result from extreme hyperglycemia or severe hypoglycemia. Let's start with hypoglycemia. Factors such as too much insulin, poor timing of insulin, too little food intake, and stressors can cause blood glucose levels to plummet. The body responds by releasing epinephrine, glucagon, and cortisol and by activating the sympathetic nervous system, or SNS. This response causes the signs and symptoms of hypoglycemia, such as sweating, dizziness, confusion, hunger and heart
palpitations. In order to counteract hypoglycemia and these effects, glucose, in some form, is needed by the body.
In the Somogyi effect, nocturnal hypoglycemia causes a counter response and overcompensation by the body, resulting in morning hyperglycemia. Morning hyperglycemia also occurs in the dawn phenomenon. There is no nocturnal hypoglycemia, however, growth hormone peaks at night and this hormone keeps glucose elevated, resulting in morning hyperglycemia.
Now, let's turn our
attention to complications associated with hyperglycemia, starting with the three polys. Polyuria is increased urination. Elevated glucose in the blood increases glucose filtration in the kidneys. And where glucose goes, water follows, thus increased urination.
Polydipsia is increased thirst. Hyperglycemia results in increased osmolarity of serum and causes water to shift from inside to outside the cell. These both initiate the thirst mechanism.
Polyphagia is increased eating. In a strange
way, this is a manifestation of the idea "starvation in a time of plenty." High blood glucose represents "plenty" of fuel; however, the glucose cannot be used without effective insulin. Because the body cannot use the glucose, it responds as if it were in starvation, increasing hunger and elevating blood glucose further.
Now, let's look at specific acute complications for each form of diabetes, beginning with type 1 and diabetic ketoacidosis, or DKA. When someone with type 1 diabetes forgets
to take insulin or does not take enough insulin, blood glucose rises. The body cannot use the glucose and perceives starvation, and begins lipolysis. This fat breakdown leads to ketone formation. As ketones accumulate in the blood, the blood becomes acidic, leading to clinical manifestations. Ketone formation may cause the breath to smell fruity. As pH is lowered by ketones, hyperventilation, specifically Kussmaul Respirations, occurs in attempt to raise pH by exhaling carbon dioxide. The person
may demonstrate signs of dehydration, the three "polys," and nausea and vomiting. In addition, fluid and electrolytes imbalance may occur. Treatment of DKA includes insulin to enable the body to use glucose, fluid replacement, and giving potassium.
People with type 2 diabetes are at a greater risk for developing hyperosmolar hyperglycemic syndrome, or HHS. Let's consider the name. Hyperosmolar refers to the osmotic pressure exerted by elevated serum glucose. Hyperglycemia denotes that
elevation. Syndrome simply refers to the signs and symptoms of this condition.
Some of the signs and symptoms that occur in HHS include:
Dehydration
Polyuria
Low blood pressure due to fluid volume loss, and
Elevated heart rate as the body compensates for low blood pressure.
Similar to DKA, fluid replacement and insulin are required treatments.